Reducing Tobacco Use and Secondhand Smoke Exposure: Quitline Interventions. Summary Evidence Table: Provider Referral to Promote Quitline Use

Transcription

1 Reducing Tobacco Use and Secondhand Smoke Exposure: s Summary Evidence Table: Provider Referral to Promote Use Bentz et al. (2006) Non-Randomized Trial (Greatest) Fair (3) Oregon, USA : Fax Referral Provider actively refers smokers who are interested to the quitline by faxing the patient s form. Upon receipt of the fax referral, the quitline counselor proactively calls the tobacco user, develops an in-depth quit plan, and offers the quitline services to those who are interested. : Brochure Referral Smoker is given a brochure by the provider and urged to initiate contact with quitline if interested in quitting : 10/ /2003 : 175 providers in 19 clinics with a total of 103,597 patients seen, with 15,662 being current smokers. All Patient s who were identified as smokers were eligible to receive the intervention once they consent to the study ( n): 496 (n): % (249) 59% (292) Difference +40 pct pts Relative Change 210.5% Analysis Completed 10-12/03 Borland et al. (2008) Group RCT (Greatest) Victoria, Australia : Fax Referral GPs encouraged to refer smokers with interest in : (09/ /2005) : Current Smokers, 18 yrs, spoke English, provided informed consent Total # Referred 47.5% (n=366) (Note: N=771) % of Fax Referred 1.43% (n=11) == 46.04% (n=355) pct pts Relative % 3

2 Good (1) quitting to the Victorian : In-practice Management GPs encouraged to provide smokers with additional information and help to stop smoking Computerized randomization of PCPs (GPs) in ratio 1:2 for Intv:Ctrl Participants: (n) = 30 PCPs; 728 Patients (f/u = 547@3m, 495@12m) (n) = 15 PCPs; 311 Patients (f/u = 224@3m, 195@12m) Patients Contacted by % of Contacted Patients that Enrolled prevalence at 3 Self-reported 30 day continuous abstinence at 3 prevalence at 12 == 7.7% 5.5% 9.0% 76.8%, n=281) 73.5% (n=206) 13.5% 10.2% 15.4% 5.8 pct pts (not used) 4.7 pct pts (not used) 6.4 pct pts (not used) Self-reported 30 day continuous abstinence at % 4.4% 2.8 pct pts 12 Ebbert et al. (2007) Group RCT (Greatest) MN, USA (Olmsted and Mower Counties) : Brief Counseling from Dental Hygienist + Fax Referral : : Recruitment was from 06/ /2006 : Adults>=18; dental patient coming for routine dental day abstinence at % 27.3% 47% (28 of 60) 18.3% 25.0% -4.4 pct pts (not used) -2.3 pct pts 3 6 Page 2 of 10

3 Fair (4) Brief Counseling from Dental Hygienist only prophylaxis; currently smoking Population:: 82 Patients Randomized (n):60 day abstinence at 6 (n): 22 Gordon et al. (2010) Group RCT (Greatest) Fair (2) Mississippi, USA : GRP 1: 5As (Ask, advise, assess, assist, arrange) Referral to the Mississippi quitline was optional and was at the discretion of the provider GRP2: 3As (Ask, advise, arrange quitline referral) Based on the AAR model Fax-to-Quit referral to the Mississippi quitline was offered to the participants : (10/ /2008) >= 21 yrs; Dental patient; Smoker or user of Smokeless tobacco Participants (N): 2160 GR1:5As (n): 817 GRP2:3As (n): 793 (n): 550 % Referred % (#) prevalence at 3 prevalence at 12 Control: 25.5% Control: 4.9% Control: 7.6% GRP1: 52% GRP2: 29% GRP1: 52.4% GRP2: 40.1% GRP1: 6.6% GRP2: 5.0% GRP1: 13.2% GRP2: 10.8% GRP2 vs. Control: 26.9 pct pts Relative 105.5% 3 12 : Usual Care Practitioners provided their usual tobacco-use cessation services to patients (details of the services not given) Self-reported 90 day continuous abstinence at 12 Control: 1.5% GRP1: 3.3% GRP2: 3.0% GRP2 vs. Control: 1.5 pct pts 12 Guy et al. (2012) Arizona, USA Referral Types and Population: prevalence at 7 Provider passive referral: 8.36% Provider active referral: 10.55% 7 Page 3 of 10

4 Retrospective (Moderate) Good (1) Self-Referral: Client contacts ASHLine on his own volition Personal Passive Referral: Client encouraged to contact ASHLine by non-medical professional like family, friends All clients enrolled between 07/01/ /27/2010 (from records) Total N = 11,040 No allocation was done Self-reported 30 day continuous abstinence at 7 Provider passive referral: 8.17% Provide active referral: 9.86% difference: 1.7 pct pts 7 Provider Passive Referral: Client encouraged to contact ASHLine by medical professional but were not formally referred Provider Active Referral: Client willing to quit were fax/mail referred to ASHLine Kobinsky et al. (2010) Retrospective (Moderate) Good (1) Wisconsin, USA : Fax To Quit: Clients who were Fax Referred to WTQL by Health Professional : Non-Fax To Quit: Clients who were Verbally encouraged to contact WTQL : 12/01/ /01/2007 Telephone Survey: 03/01/ /30/2007 : English speaking; >= 18 yrs; Valid phone # in WTQL database; Tobacco user prevalence at 3 Self-reported 3 continuous abstinence at % 32.7% 52.5% 46.8% 14.1 pct pts 3 3 (from records) (n): 158 Page 4 of 10

5 (n): 107 Lewis et al. (2009) RCT (Greatest) Good (1) UK GRP A: Brief Counseling + Passive referral: Brief counseling by HSCS and the provided with contact information of and verbally advised to contact Local Community-based Smoking Cessation Service GRP B: Intensive Counseling + Passive Referral: 4 Intensive Counseling sessions + 5 Information Leaflets + Verbal advise to contact Community-based Smoking Cessation Service : 05/ /2006 Consecutive smokers; >= 18 yrs; Attending Hospital Participants (N): 450 GRP A: Randomized 150 # Analyzed (n): 132 GRP B: Randomized 150 # Analyzed (n): 132 Communitybased Service % Communitybased Service % prevalence at 55 weeks GRP B: 4% GRP B: 6% GRP B: 20% GRP C: 23% GRP C: 8% GRP C: 22% difference: 19 pct pts; Relative difference: 475% difference: 2 pct pts 5wks 52wks 55wks GRP C: Intensive Counseling + Active Referral: 4 Intensive Counseling sessions + 5 Information Leaflets + Specific Appointment to attend the Community-based Smoking Cessation Service within 7 days GRP C: Randomized 150 # Analyzed (n): 129 Mahabee-Gittens et al. (2008) Ohio, USA : 2As + Fax Referral : (09/ /2006) : up till 11/2006 % Referred % Fax Received 89% (n=212) 83% Page 5 of 10

6 RCT (Greatest) Good (1) Brief Tobacco cessation information based on the first 2As (Ask and Advise) of the 5As of the Clinical Practice Guideline, and offered a faxed referral to the telephone tobacco : Usual Care Control Patients were surveyed and given informed consent only no cessation information : Parent or legal guardian of children 18 years or younger; triaged to the non-urgent category; Tobacco user Participants (N): 356 Randomized to achieve a 2:1 ratio between intervention and control participants : (n): 237 completed 3m f/u (n): 120 (78%) % Enrolled % (#) prevalence at 6 weeks prevalence at 3 prevalence at 6 weeks and 3 3.4% 5.9% 1.7% 84% 46% 6.8% 11.4% 4.2% 3.4 pct pts (not used) 5.5 pct pts 2.5 pct pts (not used) 6wks 3 3wks and 3 (n): 119 completed 3m f/u (n): 65 (75%) Perry et al. (2005) Before and After (Least) Fair (4) Wisconsin, USA : Fax Referral Identification of all patients who smoke as part of a vital signs assessment and their referral to the Wisconsin Tobacco QuitLine (WTQL) through a Fax-To Quit : Implementation Started in 2003 : Patients attending 470 healthcare facilities in Wisconsin who identify as Tobacco users. ( n): NA # Referrals to 1 st Quarter 2003 N=10 4 th Quarter 2004 N=1100 Page 6 of 10

7 system after obtaining their consent : None (n): None NOTE: This paper only reported the extent to which the FTQ approach has been adopted by health care providers; it showed trend in # of referrals to the after the implementation of Fax-To-Quit. No before intervention implementation, and the 1st quarter 2003 is only for the month of March. Schiebel et al. (2007) RCT (Greatest) Fair (2) Minnesota, USA : Fax To Quit: Fax Referral for counseling involving an initial 45-minute telephone session followed by up to four minute follow-up sessions around their identified quit date : US Public Health Services Self-help Manual : 09/ /2007 (14 duration) : Current smoker; >=18 yrs; visits a primary care physician 84.5% Latino population ( n): ; f/u (n): ; f/u % Referred % Medications Control: 44% : 17% Control: 49% : 60% Control: 37% : 35% 41% Control: 65% : 63% Control: -7 pct pts : 18 pct pts difference: 25 pct pts Control: 16 pct pts : 3 pct pts difference: -13 pct pts Page 7 of 10

8 Paper is an evaluation of the of the addition of a fax referral to a provider reminder system (chart stamp) on provider adherence to the 4As (especially on # of patients referred and given medications) Sherman et al. (2008) Group RCT (Greatest) Fair (2) California, USA : EMR Computerized referral to Telephone Care Coordination Program : Usual care Analysis of Data (from TCCP records), as well as Selfreported survey of providers : 05/2003 to 03/2004 (10 duration) Setting: 18 VA sites in California : Current smoker, visit with a primary care provider Sample Frame (N): 18 Total # of Referrals Provider Selfreported Mean # of referrals in prior month Self-reported 30-day Continuous abstinence@ ( ) ( ) 11% of all patients referred to TCCP 6 ( n): 10 (n): 8 NOTE: Referrals were to the TCCP who later connected patients with s via 3-way telephone Page 8 of 10

9 Willet et al. (2009) Before and After (Least) Fair (2) Ohio, USA : Fax Referral (from Records) The Ohio Tobacco Prevention Foundation implemented 3 programs to increase provider referrals 1) A hospital base outreach to train staff at 43 participating hospitals; 2) a direct marketing initiative (Fax Five); and 3) Health professional training program : 06/01/ /01/2007) : Ohio callers in the OTQL database; Tobacco Users. ( N): Total Referred during study period (N): 6951 Average per month = 412 (range: ) % Enrolled == 23.6% : Non-fax referred quitline participants (n): None Note: Paper evaluates provider referrals from quitline records but provides no data on the outcome ments for the control group. However, paper provided a comparison of the demographic characteristics of 1616 fax referred quitline enrollees to those who were not fax referred Page 9 of 10

10 Abbreviations Ctrl, control Intv, intervention Mos, NRT, nicotine replacement therapy OR, odds ratio pct pts, percentage points SES, socioeconomic status Page 10 of 10